The tribulations of a confined shrink
- Posted by Editor JPR
- Posted in Editorials & Commentary, Lived Experience
Vol 10 #4
Caroline Giroux, MD, FRCPC
Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, [email protected]
This is not a pleonasm. During the pandemic, I discovered how far the concept of shrinking could go. A “shrink”, I recently learned, is a nickname given to psychotherapists in the 1960s based on tribal societies who apparently attempted to shrink their enemies’ heads. It now refers jokingly to a psychotherapist or psychiatrist.
Although I don’t really like the meaning, the name could still be à propos, with a different flavor to it if referring to the verb, given that the psychiatry physician might have often been associated with a form of inferior or “basement specialty” (in many hospitals, psychiatric emergencies or beds are in hidden in less accessible sections). Moreover, psychiatric care is not typically high on the list of priorities for budget allocation compared to cutting edge technology needed in other specialties, perhaps as a reflection of the stigma and shame surrounding the types of disorders it deals with.
When as a medical student I told an internal medicine resident during morning rounds that I wanted to apply to psychiatry, she replied, “so, you want to do a non-medical specialty?”. At the time, I wish I had the guts to reply that there is nothing more medical than psychiatry, as to be a competent psychiatrist, you must always rule out and keep in mind general medical conditions since they can present with emotional and behavioral dysregulations. Similarly, all doctors should be aware of prevalent psychosocial issues like domestic abuse, child neglect as they affect general health outcomes, including biological markers etc. (at least I did bring this up in my interest letter when I applied to residency in psychiatry, and I was accepted).
The shrink is often swept by waves of sweet envy as he or she sits, listens and feels more like a spectator to others’ lives than a true actor of his or her own. Therefore, we can see how the vicarious reality of such a doctor reading patients like novels might become easily “shrunk” by concepts, theories, mechanisms of disease, understanding of defenses, rather than expanded by the experiential, risk-taking qualities of real life and madness. We even retreat into the understudy role of our own existence when this aura of stigma persists and envelops our social status in certain circles. My in-laws have been more eager to ask about my husband’s ER shifts than my group therapy sessions for survivors of rape or childhood abuse.
Even for my own children, what I do has always been quite abstract compared to their dad’s glamorous ability to stitch them up on demand. It seems like not only my own role in society has shrunken, but my family’s representation of it. Ironically, our house doesn’t even have a basement (how I miss the Canadian houses!), so I cannot even expand my “basement specialty” or fully indulge in the mystical, intangible qualities of being a psychiatrist.
And then, a year ago, somewhere at the beginning of 2020, this fracture in the storyline of humanity. I was getting ready to go on stage for a performance of The Vagina Monologues, also as co-director of a group of nursing and medical students. It was February 29th, and my husband was already consumed by fright as he looked at graphs of death tolls. I had to protect my own mental space for something my crew and I had been working on for months. I would not let this or anyone interfere with a project that was so dear to me: giving a voice to women who had been oppressed while raising awareness and funds for a good cause, V Day.
I knew that such a nasty virus would not go anywhere any time soon, it would still hang around the next day (it certainly did), therefore catastrophic scenarios and other what-ifs could wait. The solitude of my journey was suddenly too spacious, almost dizzying. But it was not the time to give up hope for the world, and its cousin joy. So I gathered some ancestral feminine resilience as I played the role of a woman who was repeatedly raped during the Bosnian war. I am glad my soul didn’t let itself shrink by the prelude of this global disaster. Because from then on, our lives changed drastically, leaving too little room for any remaining freedom.
Not only were we confined at home almost overnight, but also in a specific room for doctors from which to work to ensure patient privacy. Children being homeschooled meant bringing school itself and all its multiplying supplies in an already cluttered, busy house. To quote a patient of mine, it was as if my house was “getting smaller”. My home, now mirror image of or equivalent to my life, was closing up on me. I had less space to move around, always on guard while I shook my head as I witnessed the atrophy of my kids’ good manners, as I made my way through a maze of toys, my feet fearing a Lego edge attack, or as I skillfully avoided a son waving wooden sword, chasing his brother. Another one could be running up and down the stairs naked after a shower or feeling the cold rain or the violent wind with only underwear on, throwing darts, slippers, superballs or food, it didn’t matter; their nature manifesting a highly concentrated hyperactivity genome is loud and aerodynamic, and completely normal, given the circumstances.
The landscape of my existence was reduced to a corner of my bedroom reserved for my desk space, and the poorly lit clinic office where I had to drive to access a different scenery to prevent hedonic adaptation and frequent interruptions from a teenager who liked to repeat the same alienating lines of a movie or wrestle loudly with his brothers. Plus, being at home so much seems to cause an objective increase of the clutter. Our kids even developed this weird passion for collecting big pieces of rusted metal from our expeditions in nature, hoping to display them in our saturated household. Yet, your mind doesn’t register irregularities or eye sores after a while, just like after months of living near a train track or an airport, people become accustomed to the noise from these engines.
Given my claustrophobic tendencies (once more self-diagnosed the month prior when I had decided to give up on wearing retainers at night, my mouth hating the straightjacket-like sensation), feelings of suffocation experienced by my soul were not surprising. I didn’t even have the liberty of clearing my throat or coughing as I choked on my saliva without being asked , “do you have coronavirus?” To make matters worse, border closure between my beloved country of origin and the US was predictably renewed until the 21st of the subsequent month.
Every month, my throat felt tighter as I heard the confirmation that the Canadian Prime Minister was keeping the border closed another month (I couldn’t blame him for wanting to prevent a spillover from their neighbor’s surreal disaster). I felt culturally trapped. This feeling, never experienced before, has been indescribably painful. Suddenly, a stranger delivering our groceries saying a cheerful “good evening” behind his mask as I waved through the window became an encounter worthy of an epic novel. Contacts with the outside world being so limited, almost non-existent, during my necessary self-care or gratitude time, I saw myself having conversations with any novelty in my visual field.
Seeing friends so rarely made me realize that we have friends not only because of the need to share certain aspects of ourselves, to share secrets or feel validated, but basically to recharge and be in a space with people sharing our vibrational frequency, or emotional energy, especially if the ones we live with emit a different “chi” or express it in antipodal ways. It is more about the invisible and the silent stuff than about the visible and the audible. More about the processes than the content. So I absolutely needed to protect the space I still had, reclaim the square meterage I still craved for, and inhabit it more fully. This happened through my daily minutes-long pauses in silent reflections, my captivating readings about supernatural stuff, coming back from a family walk alone and at my own pace, or allowing for a few moments of meditation before falling asleep and after waking up.
Looking for every bit of opportunity to escape a pinball machine, overwhelmingly male household well animated by three boisterous sons, their dad and the hamster (also male), I would also seize any fabricated need to walk down the street. Finding our mailbox, #8, had turned into this blessed voyage where I would get to find out if I still existed to the world, if only in some obscure medical association database for the purpose of offering me superfluous disability insurance. Seeing my name, my full name, above our address of 9 years helped me fight the deep fear of annihilation… a few months into the pandemic, I had felt an urge to connect with people abroad, longterm friendships and even a second-degree cousin after decades of silence, sending them drawings of my own doing, handmade bookmarks, as if I needed to leave a tangible piece of me, gradually falling into oblivion as our strict household rules and border closures prevented air travel, reunions, hugs, dinners at a restaurant, celebrations, trips to the museum, real-time exchanges.
As I would walk with my little golden key for #8 in hand, those very hands that had sent bits of my love to the universe, I was filled with hope that maybe, the universe had loved me back that day. Weeks or months later, one could understand the excitement of a literature and chocolate lover like me as I would unwrap a dark brown, delicate bar sculpted like the fancy front door of a mansion only to discover a mass printed love poem inside its wrapping. What a blissful juxtaposition.
Another attempt to expand or resist the removal of so many of life’s sensory pleasures, now reduced to my daily glass of wine and squares of dark chocolate, was through the colossal task of reading a Danish dictionary. I was determined to keep my brain stimulated. But even my foreign accent addiction wasn’t sufficient to keep me going, and I didn’t make it past the letter A. It just confirmed to me once again that a compulsory approach to exploration is not a fulfilling way to live. As for wine drinking, I eventually decided to do a zero-alcohol challenge (some of my folks in Quebec did “Janvier Perrier” after the holidays) because I could have easily slipped into the somewhat higher risk bracket of social drinkers (socially-deprived social drinkers… ). I stopped at day #36, the tenth of a revolution. What an encouraging evolution. I even shed a few kilograms, another example of the shrunken state of my being…
Sometimes, in our stack of mail, I find a Netflix DVD movie and I still get really excited to have novelty in my evening, usually dictated by the mood or decibel level in the male energy of the household. After I put the DVD in the reader, the impossible reconciliation of antipodal tastes through negotiation would start between 5 people in front of the only small TV of our household. They vote for Star Trek or Lord of the Rings while what I need is Pippi Longstocking or Thorn Birds.
And as far as new board games are concerned, I have been filled with a sense of growing panic, experiencing a shrinking of my executive functions as I am suddenly unable to memorize or correctly apply seemingly complicated rules. Maybe it is due to my heightened distractibility, or the saturation of my mental space as I try to simultaneously hold new patients’ stories that bear no comparison to anything from a vanished era, along with my own.
Winter sports such as skiing have also been proscribed. I went back to rollerblading, finding a small area where I would literally run in circles, discovering with some awe that this seemingly obsessive loop of the body would mysteriously unlock some energies by mobilizing them, whisking my chi towards spaces ready to use it, facilitating an access to creativity and inspiration. The straightjacket life couldn’t completely crush soul elements, I guess, and thankfully so.
So what portion was left for me, in “Libertyland”… It was about the size of a card. I started drawing again, after many years. When I started using the pastel or graphite pencil, magic would happen before my eyes, as a dialogue started between me and the ladybug or the wolf I drew as I was adding details to its face. Some mysterious energy animated my arm, a creative life force that seemed to pass through me, something that took over me. Completely under the spell, I was then, for some delightful minutes, free. Until my three enthusiastic monkeys (sometimes their dad joining them as well) started jumping around, making the walls, the floor or the table tremble, with my pen swerving and creating a mess on the image. I had to find a vacant space to create freely…
Just like this global disaster brought to light social inequities, this major life change illuminated how I had suppressed too many elements of my deep core as a woman, an immigrant, an artist. Making my way through piled up biorhythms in my household, I was forced to go deeper, inward, and rediscover my true self. I realized how the millennia-long reign of patriarchal values had affected my own divine feminine and suppressed it. Being cut from light, one must develop a night vision and learn to sharpen other senses. That is what I did. I looked at my dark moods and held them. I listened to what they had to tell me. I decoded my yearnings and regrets. With a sense of sour dread coming from the heightened uncertainty since new virus variants are being discovered, I could no longer postpone this commitment to myself: to recover all my unexpressed identities and live them.
Our own unique personality facets are our gifts to the world. Initially, I felt sad to not have been more in touch with them for so long. But the thrill of that insight overrode the pain of regret. I am reclaiming my life, my self, my language, my dreams, my feminine wholeness a day, a smile, a verse, a project, a new moon at a time. I make a point of publishing more frequently in my mother tongue (French). I try to resist the idiosyncratic, obsolete measurement system the US still insists on using, and tell the weather in Celsius and measure in centimeters (my brain has been calibrated that way anyway). I went back to tap dancing and playing musical spoons to reconnect with my Quebecois festive heritage.,
Like an inmate confined in a cell located in such a way that he or she can catch the sunrise each day, I follow the course of every bit of light and energy that crosses paths with mine. Even if external circumstances seem to reduce life opportunities by generating a sameness that runs the risk of becoming a river of forgotten dreams, our blessed inner space can always expand in this limitless, infinite continent of serenity, creativity and joy. What we imagine is often more real than the tangible. And sometimes, if we are patient, persevering and lucky, the outside follows the inside.